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NITMED TUTORIALS

NITMED TUTORIALS. SOME CLINICAL PICTURES. 1. Picture 1. 2.  Describe and give differential diagnose  Classify and treat if the swelling brilliantly transilluminate and cannot be felt separate from the testis. Qu e stio n s. 3.   Differential  Hernia  Hydrocele

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NITMED TUTORIALS

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  1. NITMED TUTORIALS SOME CLINICAL PICTURES 1

  2. Picture1 2

  3.  Describe and give differentialdiagnose  Classify and treat if the swelling brilliantly transilluminate and cannot be felt separate from the testis Questions 3

  4.  Differential  Hernia  Hydrocele  Otherdifferentials;  Lipoma of thecord  Lymphangiectasis of thecord Varicocele Funiculitis Answers 4

  5.  Hydrocele  Abnormal collection of fluid within the tunica vaginalisof thetestis.  Classificationas; Communicating and non-communicating Or Congenital acquired; primary orsecondary 5

  6.  Primary/idiopathic  Congenital  Infantile  Funicular  Encysted hydrocele of thecord  Hydrocele of canal ofnuck  Vaginalhydrocele  Secondary  Trauma  Inflammation-epididymoorchitis  Lymphaticobstruction-filariasis  Tumour 6

  7.  Treatment  Paeditrics ;herniotomy  Adult;hydrocelectomy 7

  8. Picture2 bbinyunus2002@gmail.com 8

  9.  Describe thepathology  What are thetypes  What is the timetable of testiculardescent  What factor affect testiculardescent  How is ittreated  What are thecomplications Questions bbinyunus2002@gmail.com 9

  10.  Left undescendedtestes  True undescended orretractile  Timetable;  3rd month intrauterine- iliacfossa  7th month of fetal life- deep inguinalring  Later part of 7th month travels down the inguinalcanal  8th month IU- superficialring  9th month shortly before birth drop into thescrotum  Right testis descends beforeleft Answers bbinyunus2002@gmail.com 10

  11.  Favours;  Shorting ofgubernaculum  Differential body growth in relation togubernaculum  Raise intraabdoinalpressure  Higher body temperature inside theabdomen  Development and maturation ofepididymis  Hormones; hCG, testosterone andDHT Factors affectingdescent bbinyunus2002@gmail.com 11

  12.  Factorsinterfering  Retroperitonealadhesion  Obstruction at the deepring  Short vasdeferens  Short testicularvessels  Short pampiniformplexus  Insufficient pull by the gubernaculumtestis  Deficient hormonalstimulation  Prunebelly  External exposure to estrogen during the 1sttrimester bbinyunus2002@gmail.com 12

  13.  Treatment  Orchidopexy ;before2year  Orchiectomy;  Atrophictestis  Adolescence and adult ; risk of malignanttransformation  Intra-abdominal that cannot be broughtdown  Complication  Infertility  Trauma/torsion/tomour  Hernia  inflammation bbinyunus2002@gmail.com 13

  14. bbinyunus2002@gmail.com 14

  15. 1. identify thispathology 2. how is itclassify mention two diagnostic clinical features in this photo. what could be two major problems ifunrepaired? what will you advise the parentsagainst? list three components of surgicalrepair. bbinyunus2002@gmail.com 15

  16. hypospadias Classify as; glandular, coronal,penile, penoscrotal, scrotal,perineal. ventral urethral meatus, hoody, chordee,median grooving of the glans, spatulation of theglans (a) body wetting during urination, (b) psychological problems, (c) sexual problems, (d) socialstigmatization advise againstcircumcision (a) orthoplasty, (b) urethroplasty,(c) glanduloplasty (d) meatoplasty, (e)scrotoplasy, bbinyunus2002@gmail.com 16 (f) skincover

  17. bbinyunus2002@gmail.com 17

  18.  Identify and givedifferentials  How is itclassified  How is ittreated  What are thecomplication  What syndromes could be associated withit bbinyunus2002@gmail.com 18

  19.  Strawberryhemangioma  Portwine stain(naevusflammeus)  Salmonpatch  Hemangioma are classifiedas  Capillary, cavernous ormixed  Treatment  Reassure and observe lesion regresses spontaneously(during this period, cosmetic creams can be used tocamoflage)  Corticosteroids; intralesional triamsinolone or oral prednisolone  Sclerotherapy  Embolization  Lasertherapy  Surgicalexcision  Radiotherapy  Capillaryhemangioma bbinyunus2002@gmail.com 19

  20.  Atrophy of overlyingskin  Ulceration  Haemorrhage  Calcification  Thrombosis  Infection  Recurrence  Pressure effect especially in skeletal hemangioma; osteoporosis or bonyerosion  Limbovergrowth  Huge hemangioma can cause congestive cardiacfailure  Complications related tosyndromes  Complications ofhemangioma bbinyunus2002@gmail.com 20

  21.  Kassabach Merritt syndrome; haemangioma assiociated with thrombocytopenia  Maffucci’s syndrome; haemangioma associated with dyschondroplasia  Von Hippel-Ladau syndrome; hemangioma of the faceassociated with cerebellar hemangioma, glaucoma and pancreaticdisease  Sturge-Weber syndrome; hemangioma associated with ipsilateral glaucoma, intracranial hemangioma and focalepilepsy  Osler Rendu-Weber syndrome; hemangioma of GI, Urinarytract, liver, spleen andbrain  Klippel Trenauny- Weber syndrome ; associated osteohypertrophy of the extremities and AVfistula  Syndromes associated withhemangioma; bbinyunus2002@gmail.com 21

  22. bbinyunus2002@gmail.com 22

  23.  What is the common name of thislesion?  What is the other name that it is also called that depicts its pathogenesis?  What is thepathogenesis?  List two (2) other sites of occurrence, though lessfrequent  Name a striking lesion, though infrequent, that may beassociated  List 2 diagnostic clinical signs of thislesion.  List two (2) effective modalities oftreatment.  Complications bbinyunus2002@gmail.com 23

  24.  Cystichygroma  Lymphangioma or hydrocele of theneck  Types; capillary, cavernous lymphangioma and cystichygroma  Pathogenesis; benign proliferation of the lymphatic tissue that donot communicates freely with the lymphaticsystem.  Sites  1. Posterior triangle of the neck—75%—most commonsite.  Eventually may extend upwards in theneck  2.Axilla—20%  3.Cheek  4. Tongue—lymphangiogeneticmacroglossia  5.Groin  6.Mediastinum  7. Often multiplesites bbinyunus2002@gmail.com 24

  25.  May be associated withmacroglosia  Swelling is smooth, soft, fluctuant (cystic), not compressible, brilliantly transilluminant. It isnot reduciblecompletely.  Treatment  Surgicalexcision  Sclerotherapy ; for recurrent lesion. Scelosant ; bleomycin,sodium tetradecyl sulphate and glucose,Ok-432  External beamradiation  Complications;  Airway obstruction, infection, hemorrhage into cyst, insinuation into major structures, obstructedlabour bbinyunus2002@gmail.com 25

  26. bbin yunus2002@gmail.com26

  27. Identify thisabnormality • How is itclassified • What is theaetio-pathology? • List 2 clinical conditions that may beassociated. • List 3 complications of thiscondition. • State the timing and type of a correctiveoperative • technique for thiscondition. • State another specialist, apart from a plasticsurgeon, that should be involved in management of thisboy 27

  28.  Cleftlip  Classification;  Central cleft-rare  Lateralcleft  Unilateral orbilateral  Complete(extend into the nostril) orincomplete  Simple or compound(associated with cleft ofalveolus)  Complicated(associated with cleft palate) oruncomplicated  Aetio-pathology  Both genetic and environmentalfactor  15% are familial through male sex-linked recessivegene bbinyunus2002@gmail.com 28

  29.  Nutritional deficiency; Vit B, Vit A folicacid.  Rubella infection  Drugs; steroid,phenytoin,diazepam  Anoxia  Radiation  Stress  Advance maternalage  Diabetic  Consanguineousmarriage  In association with othersyndrome; bbinyunus2002@gmail.com 29

  30.  Cleft palate and VACTARLabnormality  Complications of cleftlip;  Cosmeticallyugly  Defective suction during breastfeeding  Dentalirregularity  Defective speech with particularly with labial letters ; B,F,M,P,V,W  Timing for correctiveoperation  Millard rule of 10; child shouldfulfil  ≥10weeks  10lbs(4.6kg)  Hb10g bbinyunus2002@gmail.com 30

  31.  So the operation is performed when the child is 2.5- 3month  Patient’s nutrition is accepted for GA andoperation  Lips element are larger and repair is precise andeasy  Dropper feed is easier post operatively to facilitate healing  Operativetechnique  Millard’s rotation advancementflap  Tennison- Randall triangularflap  Multidisiplinary ; plastic surgeon, orthodontist, paedo- dentist, paediatrcian, speech therapist, ENTsurgeons bbinyunus2002@gmail.com 31

  32. bbinyunus2002@gmail.com 32

  33.  Identify thepathology  Classify  What are problems associated withit  How is itcorrected  What is the optimum time forrepair bbinyunus2002@gmail.com 33

  34.  Cleft lip andpalate  Classification of cleftpalate Incomplete  Bifidauvula  Cleft of soft palate along its entirelength  Cleft of the whole length of the soft palate and the posterior part of the hardpalate.(intra-maxillary) Complete  Cleft soft palate and whole length of the hadpalate bbinyunus2002@gmail.com 34

  35.  Problems associated with cleftpalate;  Defectivesuction  Defective speech consonant like;B,D,K,P,T  Defectivesmell  Defective hearing and chronic otitismedia  Repeated respiratory tractinfection  Chances of aspirationbronchopneumonia  Defective dentition because of irregular development of alveolus  Cosmetically ugly look particularly when associated with cleftlip bbinyunus2002@gmail.com 35

  36.  Treatment of cleftpalate  Von Langenbeckpalatoplasty  V-Y pushbackpalatoplasty  Furlow  Others  The optimum time forrepair  14-18month ie before the child can speak (however current trend 9month -1year because child start making effort to produce understandable sounds) bbinyunus2002@gmail.com 36

  37. bbinyunus2002@gmail.com 37

  38.  List there (3) differential diagnosis of thislesion  What is the definitive diagnosis of these swellings thataresoft (butnot cystic) and tender on examination?  What is the other name the condition is known as which is based on its features?  How is itclassify  Complications bbinyunus2002@gmail.com 38

  39.  Differentials;  Lipoma  Neurofibroma  Cysticswellings  Dercum’s disease(adipose dolorosa) – multiple neurolipomatosis  Lipoma  Classification oflipoma;  Encapsulated or diffuse (in relation tocapsule)  Fibrolipoma, neavolipoma or neurolipoma(histological) bbinyunus2002@gmail.com 39

  40.  Classification  Solitary or multiple(number)  Sessile or pednculated(shape)  Anatomical  Subcuteneous  Sub-fascial  Intermuscular  Intramuscular  Subperisteal  Subsynovial  Intra-articular  Submucous  Subserosal  Subdural orextradural bbinyunus2002@gmail.com 40

  41.  Complications oflipoma;  Cosmeticallyurgly  Necrosis due to repeatedtrauma  Calcification  Haemorrhage  Infection  Lipomatosis may cause huge enlarment anddeformity  Liposarcoma  Myxomatousdegeneration  Ulceration bbinyunus2002@gmail.com 41

  42. bbinyunus2002@gmail.com 42

  43.  What investigation isshown  What are theindications  How is itreported  What are mammographic findings ofmalignancy bbinyunus2002@gmail.com 43

  44.  Mammography  Indications;  Screening ; women >50year or >35years with riskfactors  Diagnostic mammography to evaluate existing feature of breast disease  Obesepatient  Whenever breast conservation isplanned  To rule out tumour in the contralateralbreast  Mammography guidedbiopsy  Follow up of benign breast disease with malignantpotential  Follow up after conservative breastsurgery  mastalgia bbinyunus2002@gmail.com 44

  45.  BIRADS- breast imaging reporting and datasystem  Grade -features  0- need for furtherimaging  1-negative  2- benign (repeat mammography in1year)  3- probably benign (mammography in6month)  4- suspicious as carcinoma(biopsy)  5- highly suggestive ofcarcinoma(biopsy)  6- knowncarcinoma bbinyunus2002@gmail.com 45

  46.  Mammographic findings ofmalignancy;  Microcalcification  Branchingcalcification  Spiculations  Ductal distortion  Masseffect  Loss ofsymmetry  Clustering bbinyunus2002@gmail.com 46

  47. bbinyunus2002@gmail.com 47

  48.  Spotdiagnosis  How is pathologyclassified  How would this patient betreated bbinyunus2002@gmail.com 48

  49. Ans;  Double-bubble sign- duodenalatresia  Types ofatresia;  Type1-mucosal defect with continuity of thewall-20%  Type 2- lumen atretic with fibrous cord btw proximal and distallumen  Type 3a – complete atresia with V shape mesentericdefect  Type 3b- apple peel or chrismas treedeformity  Type 4 – multiple atresia  Adequateresuscitation  N-G tubedecompression  Iv fluid, fluid and electrolytecorrection  Antibioticprophylaxis  Vit Kprophylaxis  Doudenoduodenostomy bbinyunus2002@gmail.com 49

  50. a) What is the spotdiagnosis State 3 other parts of the body that may have this type ofabnormality. List 4 Aetiologic/Risk factors thatmay predispose to thiscondition. List 4 complications of this condition. (e)List 2 surgical treatmentoptions. bbinyunus2002@gmail.com 50

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